ACA Update: Designing Consumer Insurance Assistance Programs

ACA Update: Designing Consumer Insurance Assistance Programs

Thursday, March 14, 2013

Robert Wood Johnson Foundation

Under the Affordable Care Act (ACA), programs will be established to help consumers understand and make decisions about health insurance plans. Agencies and individuals with community ties are likely to be the best candidates to fulfill ACA requirements to provide impartial education, enrollment assistance, and culturally appropriate help. A March 2013 Issue Brief explains start-up issues for these assistance programs--variably called navigators and in-person assisters--in terms of:

Legislative requirements and links to HHS rules on navigator programs.

How assistance will interface with the existing universe of licensed insurance "producers" and public enrollment/eligibility programs under Medicaid and CHIP.

The potential role for navigators to help consumers with appeals and grievances.

Options for states in funding navigator programs (e.g., per application, incentive payments).

Options for navigator program design (e.g, how assistance can be handled by current programs, potential need for more assistance in the first years of operation with scale-down over time, how to coordinate and manage programs).